Adoption Application

PERSONAL INFORMATION:

 

NAME_______________________________________________________

Home Phone: ______________________ Cell #: _____________________

Spouse’s Name (if applicable): ______________________________________

How many children in your home? __________ Ages: ____________________

Are there any others residing in your home? Please List:_____________________

Employer Name: ______________________________ Phone: ______________

Employer Address: _________________________________________________

City: ________________________________ State:__________Zip: __________

How long have you been there? : _____________________________________

Residential Information:

 Home Address: ______________________________________________________

City: ______________________________ State: __________ Zip: ________

Is this where the pet will live with you? ____________

How long have you resided at this address? __________________________

If less than two years, what was your previous address? _________________

_______________________________________________________________

Do you Rent or Own? ______________ Apartment? _______ House? _______

What happens to the pet if you move?_____________________________________________

If Renting, what is your Landlord’s name and phone #?____________________________

Have you received permission from your landlord? ___________________

Name and phone of one personal, character reference. This person can not be related to you. ________________________________________________________________

Name and phone of one personal, character reference. This person must be related to you but not living in your household. ______________________________________________

Other Adoption Information:

Please name/describe the pet you are interested in. ______________________________

What do you think makes this particular pet a good choice for you? __________________

________________________________________________________________________

Have you had experience with this particular breed? ______________________________

Do you have a fence around your yard? Please describe: __________________________

_______________________________________________________________________

How will you exercise your pet? ______________________________________________

________________________________________________________________________

How many hours are you away from home during the average work day? _____________

Where will your pet be kept during that time?____________________________________

Where will your pet be sleeping during the night? ________________________________

What kind of other pets do you have in the home? Please list:

 _______________________________________________________________________

Are they all current on their vaccinations? ______________________________________

 

Your Veterinarian’s Name: __________________________________________________

 City: ________________________ Phone Number: ______________________________

Does anyone in the household have allergies/asthma? ____________________________

 Have you or anyone in your household ever been convicted of animal cruelty, neglect,

or abandonment? _________________________________________________________

Have you ever taken an animal to the local shelter? What were the circumstances? ________________________________________________________________________

Have you ever had to give up a pet? Please explain: ______________________________

________________________________________________________________________

How would you handle a situation where your animal developed behavioral issues? ________________________________________________________________________

Are there any other comments you would like to make? ____________________________

________________________________________________________________________

 

I, (name)__________________________________ certify that all information provided on this form is true to the best of my knowledge. I give permission to Change of Fate Rescue or their named representative to verify the information I have provided. I understand that a criminal background check and home check will be mandatory prior to adopting a pet. I understand any false statement or deliberate misrepresentation of the facts will result in immediate denial of this application. And that money is due at this time.

 

 

Signature: ___________________________________ Date: __________________